Nuffield Trust: the gender pay gap in the NHS

The Nuffield Trust | April 2018  | The gender pay gap in the NHS: the story so far

Businesses with that employ more than 250 employees across Great Britain have  recently reported details of the gender pay gap in their organisation, in line with the requirements of The Equality Act 2010 (Gender Pay Gap Information) regulations. Now John Appleby,  Director of Research and Chief Economist at the Nuffield Trust has written a blog post about the gender pay gap in the NHS.  As it is the largest single employer in Britain – three times the size of the largest private sector employer, Tesco. Most of its organisations (principally trusts) employ over 250 staff.  Appleby questions: what does the data tell us about the gender pay gap in the NHS? (Nuffield Trust)

The full post can be read here 


Managing the hospital and social care interface: Interventions targeting older adults

The Nuffield Trust | March 2018  | Managing the hospital and social care interface: Interventions targeting older adults

This research report examines the relationship between the health and social care sectors, particularly the tensions between the two due to rising pressures on hospitals, when the think tank calls for increased collaboration between the two.

Managing the hospital
Image source:

It explores the actions and strategies that providers and commissioners have put in place to improve the interface between secondary and social care, with a focus on what hospitals can do. With particular focus on:

• collaboration to prevent avoidable hospital admissions
• the interface between hospitals and social care providers when patients are
discharged from hospital
• the relationship between commissioners and social care providers
• wholescale organisational integration.



The report suggests increased

  • collaboration to prevent avoidable hospital admissions
  • the interface between hospitals and social care providers when patients are discharged from hospital
  • the relationship between commissioners and social care providers
  • wholescale organisational integration.

It uses seven case studies to support this and makes five recommendations for national policy-makers. In conjunction to this, the think tank makes  seven recommendations for hospital leaders, derived from discussion with hospitals, integrated care organisations and local authorities  throughout the course of this research.

These are:

  1. Think imaginatively about the workforce. We have already set out the recruitment and retention challenges facing the social care sector, and the way national policy needs to change to help address them. But there are also things that local providers can do.
  2. Do not make decisions about social care, without social care. Hospitals
    that make decisions about providing or commissioning social care
    without consulting their local authority or social care providers may risk
    destabilising the social care market.
  3. Think carefully about different types of integration. Organisational,
    service-level and patient-level integration all have their own strengths and
  4. Consider pooling budgets to facilitate progress. Most of our case studies
    benefited from a shared budget to initiate and sustain integration efforts.
    Some of this came from ‘vanguard’ funding, but most of the case study sites
    also drew on the Better Care Fund.
  5. Make sure that integrated teams have appropriate processes to support
    them. Where integrated teams work effectively, they have appropriate
    processual and managerial support. Shared governance and accountability
    processes mean that everyone is working to the same set of standards.
  6. Make sure that commissioners are on board. Collaboration and buy-in
    from all local commissioners and providers, including primary and
    community care, was a key factor in successful implementation for most of
    the case study sites.
  7. Collaborate with housing partners. There are good examples of
    collaboration with housing partners at the local level.

What does the Autumn Budget mean for the NHS and social care?

In the budget this week, the Chancellor committed around £2 billion extra for the NHS next year. Nigel Edwards of the Nuffield Trust said this will bring respite for patients and staff, but is only around half of what’s needed.

In a Q&A about the budget, Tom Moberly, The BMJ’s UK editor, met with John Appleby (Nuffield Trust), Anita Charlesworth (Health Foundation) and Siva Anandaciva (King’s Fund) to discuss what it all means for the NHS and social care. You can watch the discussion below:

Sustainability and transformation plans in London

Sustainability and transformation plans in London: an independent analysis of the October 2016 STPs | The Kings Fund | Nuffield Trust


This report looks at the five Sustainability and Transformation Plans in London, their contents and common themes.  The authors, from The King’s Fund and the Nuffield Trust, assess the main issues and risks to be addressed across the plans. They make a small number of recommendations for the future of the STP process in London, focusing specifically on the role of London-wide action in taking forward the plans.  The report includes a brief update on progress since March 2017.

Download the full report here

Understanding the NHS deficit and why it won’t go away

This briefing assesses the financial health of those providers by unpicking the headline figures presented in the official accounts to reveal the true underlying state of the NHS’s finances today, and to outline prospects for the next three to four years | Nuffield Trust

Image source: Nuffield Trust
  • NHS trusts have begun the current financial year, 2017/18, on course for an underlying overspend or deficit of £5.9 billion. To meet their reported deficit target of £500 million, they will need to cut their operating costs by £3.6 billion and receive temporary extra funds of £1.8 billion.
  • This would require trusts to make savings in one year equivalent to 4.3 per cent of their operating costs – far in excess of any level achieved over recent years and likely to be almost impossible to deliver.
  • A more likely scenario is that they will make cost savings similar to the level made last year. That would collectively leave the trusts with an underlying deficit of around £3.5 billion.
  • The headline deficit for 2016/17 (which ended in March 2017) was £791 million. However, that figure was flattered by billions of pounds’ worth of one-off savings, temporary extra funding and accountancy changes that did nothing to improve the underlying state of provider finances. Once they are removed, the underlying deficit for 2016/17 is £3.7 billion.
  • This is compared to an underlying deficit the year before, 2015/16, of £4.3 billion. As trusts also had to soak up additional inflation costs in 2016/17, the reduction in the underlying deficit between 2015/16 and 2016/17 actually represents providers making £2.3 billion in permanent savings.
  • Projections of future years suggest that, even under optimistic assumptions for inflation and continued high levels of savings, NHS providers will continue to run a large collective underlying deficit until at least 2020/21.

Read the full briefing here

What’s behind delayed transfers of care?

Why are we waiting? The causes of DTOCs | By Nigel Edwards for the Nuffield Trust

As the data shows, the NHS had remained responsible for the majority of DTOCs over time, but the proportion for which social care are responsible has grown by 84 per cent since December 2010.

The data also allows us to explore the reasons for delays. The most significant change since November 2010 has been an increase in the number of days delayed due to patients waiting for a care package to be available either at home (172 per cent increase) or in a nursing home (110 per cent).

While the reduced availability of social care is often highlighted as the cause of DTOCs, 57 per cent of the delays occurred because of issues in the NHS.


Read the full briefing here

Brexit means… an uncertain future for the NHS?


Both Brexit and the new government under Theresa May have major implications for the NHS. The health service is already facing financial turmoil and chronic staff shortages – both thrown into further uncertainty by the UK’s departure from the EU. But with political attention dominated by Brexit negotiations, will the service get the help it needs? Nigel Edwards sets out the challenges ahead in his latest Nuffield Trust blog .